| 刘晓荣,吴 云,蒋琳琳,张 静,姚 星,王成夭.氢化泼尼松联合泵注甲氧明预防老年患者髋关节置换术骨水泥反应的临床效果观察[J].,2019,19(15):2891-2894 |
| 氢化泼尼松联合泵注甲氧明预防老年患者髋关节置换术骨水泥反应的临床效果观察 |
| Observation on the Clinical Efficacy of Hydroprednisone Combined with Pump Injection of Methoxamine in the Prevention of Bone Cement Implantation Syndrome in Elderly Patients Undergoing Hip Replacement |
| 投稿时间：2018-11-23 修订日期：2018-12-18 |
| DOI：10.13241/j.cnki.pmb.2019.15.020 |
| 中文关键词: 氢化泼尼松 甲氧明 老年人 髋关节置换术 骨水泥植入综合征 |
| 英文关键词: Hydroprednisone Methoxamine Elderly Hip replacement Bone cement implantation syndrome |
| 基金项目:湖北省卫计委科研项目(WJ2015108) |
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| 中文摘要: |
| 摘要 目的：观察氢化泼尼松联合泵注甲氧明预防老年患者髋关节置换术骨水泥反应的临床效果。方法：将腰硬联合麻醉下行髋关节置换术的60例老年患者随机分为观察组(A组)与对照组(B组)，观察组在骨水泥植入前静脉给予氢化泼尼松0.5 mg/kg，并以3 μg?kg-1?min-1持续泵注甲氧明，对照组在相同时点给予地塞米松0.1 mg/kg。记录和比较两组患者骨水泥植入前(T0)、植入时(T1)、植入后3分钟(T2)、植入后5分钟(T3)、植入后10分钟(T4)及植入后30分钟(T5)时的动脉收缩压(SBP)、平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)及中心静脉压(CVP)、动脉血PH值、动脉氧分压(PO2)、动脉二氧化碳分压(PCO2)及血乳酸(Lac)水平的变化。结果：与T0时比较，对照组T2、T3时SBP、MAP及PO2明显下降，HR显著上升，而同时点观察组SBP、MAP及PO2较对照组明显升高，HR较对照组显著降低(P<0.05)，观察组各时点SBP、MAP及HR比较差异无统计学意义(P>0.05)。与T0时比较，对照组T3、T4时血清Lac水平显著升高(P<0.05)，同时点观察组与之比较明显降低(P<0.05)。观察组各时点pH、PO2、Lac及PCO2均无明显变化(P>0.05)。结论：老年患者行髋关节置换术在骨水泥植入前预防性给予氢化泼尼松及泵注甲氧明能使患者血流动力学平稳，改善机体微循环及组织氧供。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the clinical effects of hydroprednisone combined with pump injection of methoxamine on the prevention of bone cement implantation syndrome in elderly patients with hip replacement. Methods: Sixty elderly patients undergoing hip arthroplasty with combined spinal-epidural anesthesia were randomly divided into observation group and control group. Patients in the observation group were given 0.5 mg/kg hydroprednisone intravenously and pump injection of methoxamine 3 μg?kg-1?min-1 continuously before bone cement implantation. Patients in the control group were given dexamethasone 0.1 mg/kg at the same time. The arterial systolic pressure (SBP), mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SPO2) and central venous pressure (CVP) were recorded and compared in the two groups before bone cement implantation (T0), at implantation (T1), 3 minutes after implantation (T2), 5 minutes after implantation (T3), 10 minutes after implantation (T4) and 30 minutes after implantation (T5). The changes of arterial blood pH , arterial oxygen partial pressure (PO2), arterial carbon dioxide partial pressure (PCO2) and blood lactic acid (Lac) were observed at T0 to T5 in the two groups. Results: The SBP, MAP and PO2 were decreased while the HR increased significantly at T2, T3 compared with T0 in the control group(P<0.05), the SBP, MAP and PO2 in the observation group were significantly higher while HR were significantly lower than those in the controlled group at the same time (P<0.05). The serum lac level in the control group increased significantly at T3, T4 compared with T0(P<0.05), and it was significantly lower in the observation group than that in the control at the same time(P<0.05). There was no significant change in the SBP, MAP, HR, pH, PO2, PCO2 and Lac at different time points in the observation group(P>0.05). Conclusion: Prophylaxis of hydroprednisone and pump injection of methoxamine can make hemodynamics stable and improve microcirculation and tissue oxygen supply in the treatment of elderly patients with hip replacement before bone cement implantation. |
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